Cochlear ImplantWhat is Cochlear Implant?Read more...
LaryngectomyWhat is Laryngectomy?Read more...
MyringotomyWhat is Myringotomy?Read more...
Neck Block DissectionsWhat is Neck Block Dissections?Read more...
Nasal PolypsWhat is Nasal Polyps?Read more...
Nasal SurgeryWhat is Nasal Surgery?Read more...
OssiculoplastyWhat is Ossiculoplasty?Read more...
StapedotomyWhat is Stapedotomy?Read more...
SeptoplastyWhat is Septoplasty?Read more...
Sinus SurgeryWhat is Sinus Surgery?Read more...
TympanoplastyWhat is Tympanoplasty?Read more...
ThyroplastyWhat is Thyroplasty?Read more...
Nose RessectionWhat is Turbinates of Nose-Resections?Read more...
TonsillectomyWhat is Tonsillectomy?Read more...
What is Thyroplasty?
A thyroplasty is a surgery which is designed to address weakened vocal cords. In the surgery, the doctor changes the length or position of the vocal cords to make them stronger. This surgery can be performed to correct voice disorders and to address issues such as coughing or choking while swallowing which may arise as a result of weakening in the vocal cords. An ear, nose, and throat surgeon is usually chosen to perform the procedure.
When the vocal cords become weak, the voice can become breathy and stressed. It is difficult to talk, and the patient may feel uncomfortable with the sound of his or her voice. In addition, it can be hard for people to hear or understand the patient. The weakening can also cause problems with eating or drinking which may lead to malnutrition or unintended weight loss.
In a thyroplasty procedure, the patient is usually placed under sedation and given a local anesthetic. The surgeon makes a small incision in the neck to access the vocal cords. After making adjustments and possibly implanting a wedge to strengthen the vocal cords, the surgeon can ask the patient to talk. This allows the surgeon to judge the success of the procedure right away, and to make any needed adjustments. The procedure can take one to two hours in total.
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Different Types of Thyroplasty
Type I thyroplasty has been used for the abductor variety of laryngeal dystonia/spasmodic dysphonia. In this procedure, the vocal cords are brought closer together in hopes of decreasing the effect of the abductor spasms. Results are mixed, with some patients getting good relief, and others having minimal effect.
Type II thyroplasty is a procedure for adductor spasmodic dysphonia that involves spreading the vocal cords apart by inserting a shim that prevents them from contacting each other during the spasms that occur with this disorder. Although some have reported good relief of vocal strain, others feel the trade off to a breathy and weak voice is too excessive.
What is vocal cord paralysis?
Everyone has two vocal cords in his or her larynx (voicebox). The vocal cords vibrate during speech to produce voice. If one or both vocal cords are unable to move then the person will experience voice problems and possibly breathing and swallowing problems. This is vocal cord paralysis.
There are different types of vocal cord paralysis. Bilateral vocal cord paralysis involves both vocal cords becoming stuck halfway between open and closed (the paramedian position) and not moving either way. This condition often requires a tracheotomy (an opening made in the neck to provide an airway) to protect the airway when the person eats.
Unilateral vocal cord paralysis is when only one side is paralyzed in the paramedian position or has a very limited movement. It is more common than bilateral involvement. The paralyzed vocal cord does not move to vibrate with the other cord but vibrates abnormally or does not vibrate at all. The individual will run out of air easily. They will be unable to speak clearly or loudly.
Signs and symptoms of vocal cord paralysis
The severity of voice and swallowing problems depends on where the nerve damage occurs. Typical symptoms include:
Vocal Cord Paralysis causes
In vocal cord paralysis, the nerve impulses to your voice box (larynx) are disrupted, resulting in paralysis of the muscle. Doctors often don’t know the cause of vocal cord paralysis. Known causes may include:
Injury to the vocal cord during surgery - surgery on or near your neck or upper chest can result in damage to the nerves that serve your voice box. Surgeries that carry a risk of damage include surgeries to the thyroid or parathyroid glands, esophagus, neck, and chest.
Neck or chest injury - trauma to your neck or chest may injure the nerves that serve your vocal cords or the voice box itself.
Stroke - a stroke interrupts blood flow in your brain and may damage the part of your brain that sends messages to the voice box.
Tumors - tomors, both cancerous and noncancerous, can grow in or around the muscles, cartilages or nerves of your voice box and can cause vocal cord paralysis.
Inflammation - arthritis or surgery can cause inflammation and scarring of the vocal cord joints or the space between the two vocal cord cartilages, and this inflammation may prevent your vocal cords from opening and closing. The symptoms and signs of this disorder mimic vocal cord paralysis, even though the vocal cord nerves remain normal. In addition, some viral infections can cause inflammation and damage directly to the nerves in the larynx.
Neurological conditions - if you have certain neurological conditions, such as multiple sclerosis or Parkinson’s disease, you may experience vocal cord paralysis.
What can be done to make my Voice Better?
Injection Augmentation - a substance with a paste or gel-like consistency is injected into the paralyzed vocal fold to "bulk" it up and help to push the edge of the paralyzed vocal fold towards the normal vocal fold to allow improved closure during speech, swallowing and coughing. Most of the substances are temporary in nature, and usually are similar or the same materials that are used in cosmetic procedures to plump lips or remove lines from the face. There are some more lasting substances, but these are newer on the market. These procedures are fast and can be done either awake in clinic or in the operating room. The injection can be performed with curved instruments through the mouth, or with a needle placed through the skin or the neck. The injection usually lasts from one to three months, although some individuals achieve seemingly permanent improvement from this procedure.
Thyroplasty - a permanent wedge of material is placed deep to the vocal fold to push it to midline. Because the material is placed through the "thyroid cartilage," which is the wall of the voice box, it is called a "thyro"plasty. This procedure is usually done under local anesthesia in the operating room. An incision is made in the neck skin; a small rectangular hole is made in the thyroid cartilage with a scalpel or a dental drill just over the vocal fold. Then a permanent bio-compatible substance is placed through the hole to push over the vocal fold and secured into place. This material can be silastic, metal, ceramic, or gortex. The procedure is done awake so that the surgeon will know exactly what size and where to place the implant using the patient’s voice as vocal feedback. Usually this procedure takes two hours. The surgeon will often place a flexible nasolaryngoscope into the nose and suspend this over the patients head; in this manner s/he can both see the inside and the outside of the voice box at the same time. A small drain will be inserted to wick away any fluid, and the patient will stay overnight. Complications are rare but include trouble breathing, infection, bleeding and poor voice, requiring further procedures or revision.
Arytenoid Adduction - this procedure, usually done in combination with the thyroplasty procedure, works the joint of the vocal fold. The joint is stabilized with a suture to keep the vocal fold in the proper position for good speaking and swallowing. This part of the procedure is more demanding, although it has the same complications as the thyroplasty procedure, including the possibility of perforating the mucosa of the larynx area. Sometimes, if this happens, the procedure must be aborted to allow the perforation to heal.
Nerve Implantation - although this procedure sounds like replacement of the nerve, remember that none of these procedures restore movement. The purpose of this procedure is to maintain the proper health of the vocal fold muscle despite the nerve injury. So, just like an individual that has had nerve injury to their arm or leg, several years later that extremity is much smaller that the healthy one due to "atrophy" of the muscle. Individuals with a vocal fold paralysis can experience loss of the vocal muscle due to atrophy after loss of nerve signals. This is a more complicated procedure and is only done in certain cases.
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